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STONEWALL JACKSON MEMORIAL HOSPITAL COMPANY: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
STONEWALL JACKSON MEMORIAL HOSPITAL COMPANY (EIN 55-0422958)
Tax period
2010-10-01 to 2011-09-30
Filed
2012-05-14
IRS object ID
201201359349301065
Schema version
2010v3.4
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-05-14T08:42:29-05:00Timestamp
Tax Period End Date2011-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1Arnett & Foster PLLCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1P O Box 2629AddressLine1
CityCharlestonCity
StateWVState
ZIP Code25329ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN550422958EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1STONEWALL JACKSON MEMORIAL HOSPITAL COMPANYBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlSTONNameControl
Phone3042698059Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1230 HOSPITAL PLAZAAddressLine1
CityWESTONCity
StateWVState
ZIP Code26452ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameDodie ArbogastName
TitleCFOTitle
Phone3042698059Phone
Date Signed2012-05-04DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameHarry C HarlessName
Phone3043460441Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonAvah L StalnakerNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1230 HOSPITAL PLAZAAddressLine1
CityWESTONCity
StateWVState
ZIP Code26452ZIPCode
FieldValueIRS element (for citing)
Gross Receipts51317306GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.stonewallhospital.comWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1959YearFormation
State Legal DomicileWVStateLegalDomicile
Activity Or Mission DescriptionThe mission is to provide quality medical care to the citizens of Lewis and surrounding counties regardless of the patient's ability to pay. To enable the citizens of our service area to receive quality care close to home.ActivityOrMissionDescription
Nbr Voting Members Governing Body9NbrVotingMembersGoverningBody
Nbr Independent Voting Members8NbrIndependentVotingMembers
Total Nbr Employees530TotalNbrEmployees
Total Nbr Volunteers45TotalNbrVolunteers
Total Gross UBI12337TotalGrossUBI
Net Unrelated Business Txbl Income11337NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year56866ContributionsGrantsPriorYear
Contributions Grants Current Year79133ContributionsGrantsCurrentYear
Program Service Revenue Prior Year39331770ProgramServiceRevenuePriorYear
Program Service Revenue CY42984578ProgramServiceRevenueCY
Investment Income Prior Year989387InvestmentIncomePriorYear
Investment Income Current Year1336593InvestmentIncomeCurrentYear
Other Revenue Prior Year203771OtherRevenuePriorYear
Other Revenue Current Year224496OtherRevenueCurrentYear
Total Revenue Prior Year40581794TotalRevenuePriorYear
Total Revenue Current Year44624800TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year35400GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY33430GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year21776127SalariesEtcPriorYear
Salaries Etc Current Year23888959SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year16750135OtherExpensePriorYear
Other Expenses Current Year17403206OtherExpensesCurrentYear
Total Expenses Prior Year38561662TotalExpensesPriorYear
Total Expenses Current Year41325595TotalExpensesCurrentYear
Revenues Less Expenses Prior Year2020132RevenuesLessExpensesPriorYear
Revenues Less Expenses CY3299205RevenuesLessExpensesCY
Total Assets BOY57875135TotalAssetsBOY
Total Assets EOY58409902TotalAssetsEOY
Total Liabilities BOY8198777TotalLiabilitiesBOY
Total Liabilities EOY7588125TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY49676358NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY50821777NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionIt is the mission of Stonewall Jackson Memorial Hospital to provide the best possible combination of primary care in a safe, efficient, and compassionate manner. It is, and always shall be, our duty to assess the quality of care provided and to continue to seek methods of improving both our evaluation of and delivery of patient care. It is our unswerving faith in this mission that assures our role as a vital community hospital and as an economic resource for our community.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense29034063Expense
Revenue42933578Revenue
DescriptionStonewall Jackson Memorial Hospital provides Acute medical and outpatient services to residents of Weston, West Virginia and surrounding communities which covers 9 different counties. Services included 10,675 days of inpatient care, 81,702 outpatient visits, 15,129 emergency room visits, 1,548 ambulatory surgery visits, 4,755 Home Health visits and 35,829 Physician Clinic visits.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense42000Expense
Revenue26000Revenue
DescriptionAnnual blood screening: Stonewall Jackson Memorial Hospital provides all supplies and staff to operate the program. Excess revenue is forwarded to the local Rotary Club to promote charitable services. Other programs include: Glucose & blood pressure screenings at local Senior Center, Scoliosis screening at county elementary and middle schools, free sports physicals to middle school and high school students, October fest program to promote healthy choices to childrenunder 12 years old, events for free Osteoporosis screenings, events for free Dermascans to screen for skin cancer, and Weston Walk-run to promote exercise as a way to improve cardiac health; free women's health screening for breast and cervical cancer, free hearing screenings.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense27700Expense
Grants20000Grants
Revenue25000Revenue
DescriptionWilliam Adler Scholarship Fund - Stonewall Jackson Memorial Hospital sponsored program to provide scholarships to local graduating high school seniors who are pursuing career in the health care field through an accredited program. It is hoped that this program will encourage more students to seek health care professions and lessen the health care staffing shortage.Description

Activity Other ActivityOther

FieldValueIRS element (for citing)
Expense2600Expense
DescriptionRelay for Life sponsorDescription
FieldValueIRS element (for citing)
Total Of Other Program Service Exp2600TotalOfOtherProgramServiceExp
Total Program Service Expense29106363TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities0ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities1FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations1GrantsToOrganizations
Grants To Individuals1GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity1TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109661NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees530NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions1QuidProQuoContributions
Quid Pro Quo Disclosure1QuidProQuoDisclosure
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members9NbrVotingGoverningBodyMembers
Number Independent Voting Members8NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties1DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1Dodie ArbogastBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number3042698050TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1230 Hospital PlazaAddressLine1
CityWestonCity
StateWVState
ZIP Code264528558ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (17 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployee
John Law
President1.00X000
Joseph Snead
Vice-President40.00X240041022065
R Gerald Wood
Secretary1.00X000
Denver Turner
Treasurer1.00X000
Jean Bennett
Director1.00X000
R G Lockard
Director1.00X000
Richard Cronin
Director1.00X000
Robin Poling
Director1.00X000
Debbie Bennett
Director1.00X000
David Shaffer
Administrator40.00298096024967X
Avah Stalnaker
Administrator40.00148324011689X
Delphia Arbogast
CFO40.00108593015492X
Peter Edgerton
Physician40.00425132027303X
John Wyllie
Physician40.00401792024363X
Antoine Naim
Physician40.00353030027714X
Mario Estolano
Physician40.00291132018830X
John Burdette
Physician40.00279114024018X
FieldValueIRS element (for citing)
Total Reportable Comp From Org2545254TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation196441TotalOtherCompensation
Number Individuals GT100 K30NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
Mountain Radiology Services
21 W Third StreetWashingtonMO63090Radiology445200
Lab Corp
PO Box 12140BurlingtonNC27216Laboratory Services322916
CPS
PO Box 1000MemphisTN38148Consulting238158
Sodexo
PO Box 936522AtlantaGA503536922Consulting216342
Arnett & Foster
PO Box 2629CharlestonWV25329Accounting140493
FieldValueIRS element (for citing)
Number Of Contractors GT100 K8NumberOfContractorsGT100K
Fundraising Events19701FundraisingEvents
All Other Contributions59432AllOtherContributions
Total Contributions79133TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionPatient ServicesDescription
Business Code622110BusinessCode
Total Revenue Column42984578TotalRevenueColumn
Related Or Exempt Function Income42984578RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue42984578TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column1322597TotalRevenueColumn
Exclusion$1,322,597ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real47173Real
Personal13800Personal

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real66736Real
Personal1463Personal

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real-19563Real
Personal12337Personal

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column-7226TotalRevenueColumn
Unrelated Business Revenue12337UnrelatedBusinessRevenue
Exclusion-$19,563ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities6624244Securities
Other6359Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities6616607Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities7637Securities
Other6359Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column13996TotalRevenueColumn
Exclusion$13,996ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events5280GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events19701CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses7700FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column-2420TotalRevenueColumn
Exclusion-$2,420ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
Cafeteria Sales722310125470$125,470
Vending Machines45421070802$70,802
Miscellaneous90009937870$37,870
FieldValueIRS element (for citing)
Total Other Revenue234142TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column44624800TotalRevenueColumn
Related Or Exempt Function Income42984578RelatedOrExemptFunctionIncome
Unrelated Business Revenue12337UnrelatedBusinessRevenue
Exclusion$1,548,752ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total13430Total
Program Services13430ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total20000Total
Program Services20000ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total875499Total
Program Services591312ProgramServices
Management And General284187ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total19838964Total
Program Services13399236ProgramServices
Management And General6439728ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total734628Total
Program Services496168ProgramServices
Management And General238460ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1168973Total
Program Services789525ProgramServices
Management And General379448ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total1270895Total
Program Services858362ProgramServices
Management And General412533ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total93295Total
Management And General93295ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total138057Total
Management And General138057ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total52301Total
Management And General52301ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total1257491Total
Program Services849309ProgramServices
Management And General408182ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total155692Total
Program Services105154ProgramServices
Management And General50538ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total7426920Total
Program Services5014452ProgramServices
Management And General2412468ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total75494Total
Program Services50989ProgramServices
Management And General24505ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total647732Total
Program Services437478ProgramServices
Management And General210254ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total69999Total
Program Services47277ProgramServices
Management And General22722ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total77203Total
Program Services52143ProgramServices
Management And General25060ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total1716021Total
Program Services1159001ProgramServices
Management And General557020ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total173645Total
Program Services117280ProgramServices
Management And General56365ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
Bad Debts380301138030110
Repairs & Maintenance878019593014285005
Medicaid Provider Tax3216533216530
Continuing Education15319310346749726
Dues & Subscriptions1220308241939611

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total241450Total
Program Services201683ProgramServices
Management And General39767ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total41325595Total
Program Services29106363ProgramServices
Management And General12219232ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY162232BOY
EOY249191EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY23096BOY
EOY663502EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY6631588BOY
EOY7871244EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY1068843BOY
EOY1047805EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY342751BOY
EOY354012EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis32203130LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec22851526LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY9864500BOY
EOY9351604EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY38342445BOY
EOY37347792EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY75402BOY
EOY75402EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY1364278BOY
EOY1449350EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY57875135BOY
EOY58409902EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY5962876BOY
EOY6007407EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY26758BOY
EOY191227EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY2209143BOY
EOY1389491EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY8198777BOY
EOY7588125EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY49676358BOY
EOY50821777EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY49676358BOY
EOY50821777EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY57875135BOY
EOY58409902EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses3299205ReconcilationRevenueExpenses
Reconcilation Other Changes-2153786ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis646015OtherCostOrOtherBasis
Book Value646015BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis11661275OtherCostOrOtherBasis
Depreciation8995430Depreciation
Book Value2665845BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis18922058OtherCostOrOtherBasis
Depreciation13856096Depreciation
Book Value5065962BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis973782OtherCostOrOtherBasis
Book Value973782BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings9351604TotalOfBookValueLandBuildings
Total Revenue44624800TotalRevenue
Total Expenses41325595TotalExpenses
Excess Or Deficit For Year3299205ExcessOrDeficitForYear
Net Unrealized GL On Investments-2153786NetUnrealizedGLOnInvestments
Total Adjustments-2153786TotalAdjustments
Excess Or Deficit Per FS1145419ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt44557553TotRevenueEtcAuditedFinclStmt
Other Revenues9163OtherRevenues
Revenue Not Rptd F9909163RevenueNotRptdF990
Revenue Subtotal44548390RevenueSubtotal
Other Revenues Not Included76410OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt76410RevenueNotRptdOnFinStmt
Total Revenue Per Form99044624800TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt41258348TotExpensesEtcAuditedFinclStmt
Other Expenses Included9163OtherExpensesIncluded
Expenses Not Rptd F9909163ExpensesNotRptdF990
Expenses Subtotal41249185ExpensesSubtotal
Other Expenses Not Included76410OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt76410ExpensesNotRptdOnFinStmt
Total Expenses Per Form99041325595TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (5 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Description of Uncertain Tax Positions Under FIN 48:Part X:The organization had no uncertain tax positions under Fin 48 as reported in the financial statements.
Part XII, Line 2d - Other Adjustments:Van rent depreciation included in expenses on the financial statements 1,463. Fundraising expenses included in expenses on the financial statements 7,700.
Part XII, Line 4b - Other Adjustments:Scholarships netted against donations in the financial statements 20,000. Investment fees netted with investment income in financial statements 52,301. Gain included in expenses on the financial statement 4,109.
Part XIII, Line 2d - Other Adjustments:Van rent depreciation included in expenses on the financial statements 1,463. Fundraising expenses included in expenses on the financial statements 7,700.
Part XIII, Line 4b - Other Adjustments:Scholarships netted against donations in the financial statements 20,000. Investment fees netted with investment income in financial statements 52,301. Gain included in expenses on the financial statement 4,109.

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1Charity Golf TournamentNameOfEvent1
Gross Receipts Event124981GrossReceiptsEvent1
Charitable Contributions Event119701CharitableContributionsEvent1
Gross Revenue Event15280GrossRevenueEvent1
Cash Prizes Event11000CashPrizesEvent1
Rent Facility Costs Event16152RentFacilityCostsEvent1
Other Direct Expenses Event1548OtherDirectExpensesEvent1
Gross Receipts Total24981GrossReceiptsTotal
Charitable Contributions Total19701CharitableContributionsTotal
Gross Revenue Total Events5280GrossRevenueTotalEvents
Cash Prizes Total Events1000CashPrizesTotalEvents
Rent Facility Costs Total Events6152RentFacilityCostsTotalEvents
Other Direct Expenses Total Events548OtherDirectExpensesTotalEvents
Direct Expense Summary Events7700DirectExpenseSummaryEvents
Net Income Summary-2420NetIncomeSummary

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free Care0FPGReferenceFreeCare
FPG Reference Discounted Care0FPGReferenceDiscountedCare
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget1ExpensesExceededBudget
Unable To Provide Care0UnableToProvideCare
Annual Community Benefit Report0AnnualCommunityBenefitReport

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense593666TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense593666NetCommunityBenefitExpense
Percent Of Total Expense0.01580PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense8333639TotalCommunityBenefitExpense
Direct Offsetting Revenue6678838DirectOffsettingRevenue
Net Community Benefit Expense1654801NetCommunityBenefitExpense
Percent Of Total Expense0.04410PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

FieldValueIRS element (for citing)
Total Community Benefit Expense570791TotalCommunityBenefitExpense
Direct Offsetting Revenue90559DirectOffsettingRevenue
Net Community Benefit Expense480232NetCommunityBenefitExpense
Percent Of Total Expense0.01280PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense9498096TotalCommunityBenefitExpense
Direct Offsetting Revenue6769397DirectOffsettingRevenue
Net Community Benefit Expense2728699NetCommunityBenefitExpense
Percent Of Total Expense0.07270PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Number Of Activities Or Programs9NumberOfActivitiesOrPrograms
Persons Served2700PersonsServed
Total Community Benefit Expense42000TotalCommunityBenefitExpense
Direct Offsetting Revenue26000DirectOffsettingRevenue
Net Community Benefit Expense16000NetCommunityBenefitExpense
Percent Of Total Expense0.00040PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Number Of Activities Or Programs3NumberOfActivitiesOrPrograms
Persons Served32PersonsServed
Total Community Benefit Expense27300TotalCommunityBenefitExpense
Direct Offsetting Revenue10800DirectOffsettingRevenue
Net Community Benefit Expense16500NetCommunityBenefitExpense
Percent Of Total Expense0.00040PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense5770TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense5770NetCommunityBenefitExpense
Percent Of Total Expense0.00020PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs12NumberOfActivitiesOrPrograms
Persons Served2732PersonsServed
Total Community Benefit Expense75070TotalCommunityBenefitExpense
Direct Offsetting Revenue36800DirectOffsettingRevenue
Net Community Benefit Expense38270NetCommunityBenefitExpense
Percent Of Total Expense0.00100PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs12NumberOfActivitiesOrPrograms
Persons Served2732PersonsServed
Total Community Benefit Expense9573166TotalCommunityBenefitExpense
Direct Offsetting Revenue6806197DirectOffsettingRevenue
Net Community Benefit Expense2766969NetCommunityBenefitExpense
Percent Of Total Expense0.07370PercentOfTotalExpense

Workforce Development WorkforceDevelopment

FieldValueIRS element (for citing)
Total Community Building Expense118937TotalCommunityBuildingExpense
Net Community Building Expense118937NetCommunityBuildingExpense
Percent Of Total Expense0.00320PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Total Community Building Expense118937TotalCommunityBuildingExpense
Net Community Building Expense118937NetCommunityBuildingExpense
Percent Of Total Expense0.00320PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported0BadDebtExpenseReported
Bad Debt Expense$1,564,939BadDebtExpenseAmount
Amount Reimbursed By Medicare8202753AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare8384925CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-182172MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1Stonewall Jackson Memorial HospitalBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1230 Hospital PlazaAddressLine1
CityWestonCity
StateWVState
ZIP Code26452ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1Stonewall Jackson Memorial HospitalBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
Eligibility Criteria Explained0EligibilityCriteriaExplained
Uses FPG Free0UsesFPGFree
Uses FPG Discounted0UsesFPGDiscounted
Explains Basis1ExplainsBasis
Income LevelXIncomeLevel
Asset LevelXAssetLevel
Medical IndigencyXMedicalIndigency
Explains Application Method0ExplainsApplicationMethod
Includes Publicity Measures1IncludesPublicityMeasures
Posted In Emergency RoomXPostedInEmergencyRoom
Posted In Admission OfficeXPostedInAdmissionOffice
Available On RequestXAvailableOnRequest
Actions On Nonpayment0ActionsOnNonpayment
Collection Activities0CollectionActivities
Nondiscrim Emergency Care Policy1NondiscrimEmergencyCarePolicy
Amounts Generally Billed0AmountsGenerallyBilled
Gross Charges0GrossCharges

Form990 Schedule H Part VI Form990ScheduleHPartVI (9 entries)

ExplanationExplanation
Part I, Line 3c: WV food stamp eligibility guidelines are used. We have signes posted at registration, around and in the emergency department and in all physician clinics. We send letters to patients who are not paying their bills. We give the application to private pay inpatients. We also tell the patients when during telephone conversations if the patient indicates he/she is not able to pay the bill or pay all of the bill.
Part I, Line 7: The cost of charity care was estimated using a cost to charge ratio derived from Worksheet 2 of the Schedule H instructions.The unreimbursed cost of Medicaid was estimated using a cost to charge ratio derived from Worksheet 2 of the Schedule H instructions.
Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 3803011.
Part II: We recruit physicians to this area based entirely on what services the patients need. Our goal is to be able to provide physicians who can address these needs in the community.
Part III, Line 4: Patient accounts receivable are carried at the original charge less an estimate made for doubtful or uncollectible accounts. The allowance is based upon a review of the outstanding balances aged by financial class. Management uses collection percentages based upon historical collection experience to determine collectibility. Management also reviews troubled, aged accounts to determine collection potential. Patient accounts receivable are written off when deemed uncollectible. Recoveries of accounts previously written off are recorded as a reduction to bad debt expense when received. Interest is not charged on patient accounts receivable
Part III, Line 9b: Our collections policy applies to all patients regardless of financial class or any other classification. During our collections process, if the patient indicates they do not have the ability to pay their bill, the credit staff offers exoneration.
Part VI, Line 3: We have signs posted at Registration, around and in the Emergency Department and in all physician clinics. We send letters to patients who are not paying their bills. We give the application to Private Pay inpatients. We tell the patients when during telephone converations if the patient indicates he/she is not able to pay the bill or pay all of the bill.
Part VI, Line 4: Stonewall Jackson Memorial Hospital serves a relatively large rural population of about 65,000 people with an average household income of $32,000. 30% of the population is disabled. Approximately 30% are Medicaid Eligible or are uninsured. We are the largest hospital in our service area, which includes two other hospitals, one being a Critical Access Hospital. We are located in a federally-designated medically underserved area.
Part VI, Line 6: Stonewall Jackson Memorial Hospital (SJMH) is a 70 bed rural acute hospital located in Lewis county West Virginia. SJMH is the only hospital located in the county as such it is solely responsible for the healthcare of this rural community. SJMH provides 24 hours Emergency Room and Obstetrics services and provides care regardless of the patient's ability to pay. The majority of the governing body is comprised of community members. Medical privileges are offered to all qualified physicians in the community and SJMH has worked diligently to provide other physician services by expanding the services they provide.SJMH continues to make capital improvement to the facility and expand patient care services to meet the needs of the community.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1Rotary Club of WestonBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1PO Box 222AddressLine1
CityWestonCity
StateWVState
ZIP Code26452ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient550371556EINOfRecipient
IRC Section501(c) (4)IRCSection
Amount Of Cash Grant13430AmountOfCashGrant
Purpose Of GrantThe purpose of the donation is to promote charitable services.PurposeOfGrant

Form990 Schedule I Part III Form990ScheduleIPartIII

FieldValueIRS element (for citing)
Type Of GrantNursing School Scholarships for recent high school graduates.TypeOfGrant
Number Of Recipients24NumberOfRecipients
Amount Of Cash Grant20000AmountOfCashGrant

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Substantiation Required1SubstantiationRequired
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (8 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Joseph Snead
24004100000120020119210263964000
David Shaffer
29809600000149050122100325211000
Avah Stalnaker
148324000007416055200161260000
Peter Edgerton
4251320000021257083140454703000
John Wyllie
4017920000020090064200428302000
Antoine Naim
35303000000176520123260383008000
Mario Estolano
2911320000014557063930312082000
John Burdette
27911400000139560114690304539000

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
Form 990, Part VI, Section A, line 3Management duties customarily are performed under the direct supervision of officers, directors, trustees or key employees, but the Hospital has contracted out the management duties of the Maintenance department. The manager of the Maintenance department (also considered a department head) is employed by the Maintenance company. All other Maintenance staff are employees of the Hospital. The Hospital contracts out the management duties of the Pharmacy department. The manager of the Pharmacy department (also considered a department head) is employed by the Pharmacy company. All other Pharmacy staff are employees of the Hospital.
Form 990, Part VI, Section B, line 11The process the Hospital uses to review their 990 before filing with the IRS is the CFO is responsible for reviewing the form 990 for completeness and accuracy. A completed copy is provided for the board. It is then signed and submitted to the IRS.
All board members disclose possible conflicts of interest prior to appointment and periodically throughout their terms as trustees.Form 990, Part VI, Section B, line 12c
The Hospital obtains salary survey data. Performance evaluations are done on each of these personnel & financial conditions are considered.Form 990, Part VI, Section B, line 15
The Hospital places a publication in the local newspaper stating the governing documents, conflicts of interest policy and financial statements are available upon request. The policies and procedures are on the Stonewall Jackson website.Form 990, Part VI, Section C, line 19
Changes in Net Assets or Fund Balances:Net unrealized losses on investments: -2,153,786.Form 990, Part XI, line 5:
Clarification of 'yes' responseThe organization has not changed its process for oversight of the audit during the year.Form 990, Part XII, Line 2c

Schedule R IRS990ScheduleR

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1Stonewall Home Oxygen Therapy IncBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1100 Market Place Mall Suite 8AddressLine1
CityWestonCity
StateWVState
ZIP Code26452ZIPCode
FieldValueIRS element (for citing)
EIN550754278EIN
Primary ActivityOxygen Therapy ServicesPrimaryActivity
Legal Domicile StateWVLegalDomicileState
Direct Controlling Entity NAN/ADirectControllingEntityNA
Type Of EntityCTypeOfEntity
Share Of Total Income17975ShareOfTotalIncome
Share Of EOY Assets331212ShareOfEOYAssets
Percentage Ownership1.00000PercentageOwnership
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties1ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org1OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (3 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolved
Stonewall Home Oxygen Therapy Inc
A55707
Stonewall Home Oxygen Therapy Inc
P247837
Stonewall Home Oxygen Therapy Inc
Q30385